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Cited by 122Eosinophilic Disorders and SyndromesViral Infections and Immunology ResearchTakotsubo Cardiomyopathy and Associated Phenomena

Cardiac Localization of Eosinophil-Granule Major Basic Protein in Acute Necrotizing Myocarditis

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deMello, Daphne E., Liapis, Helen, Jureidini, Saadeh, Nouri, Soraya, Kephart, Gail M., Gleich, Gerald J.·1990·New England Journal of Medicine
DOI 10.1056/nejm199011293232207
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Abstract

THE association of eosinophilia and endomyocarditis has been well documented. A form of Loffler's endocarditis,1 characterized by eosinophilic pancarditis, muscle necrosis, and arteritis, is usually a feature of certain systemic diseases, including the hypereosinophilic syndrome,2 3 4 eosinophilic leukemia,5 polyarteritis nodosa,6 , 7 drug-induced hypersensitivity,8 bronchial asthma,9 10 11 biliary tract carcinoma,12 and parasitic disease.13 The cardiac involvement is characterized by a subacute course and symptoms of congestive heart failure. Treatment with glucocorticoids and cytotoxic agents is effective.14 Fulminant acute necrotizing eosinophilic myocarditis occurring in the absence of notable extracardiac disease has been reported only rarely.15 The disease has a short course and is rapidly fatal. . . .

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  • Cytokines and granule contents released by eosinophils including major basic protein are highly proinflammatory and cytotoxic in the heart.

    “The cytokines and granule contents released by eosinophils including major MBP (major basic protein) are known to be highly proinflammatory and cytotoxic in the heart.”

    From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [206]

    The Discussion (p. 3) says eosinophil degranulation releases proteins including major basic protein, and that granule proteins are cytotoxic and induce myocardial damage. It does not address eosinophil-released cytokines or describe those cytokines as proinflammatory and cytotoxic in the heart. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Eosinophils likely play a pathogenic role in eosinophilic myocarditis, contributing to inflammation and subsequent fibrosis and heart failure.

    “Eosinophils likely play a pathogenic role in eosinophilic myocarditis, contributing to inflammation and its subsequent consequences such as fibrosis and heart failure conditions.”

    From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [206]

    The Discussion (p. 3) suggests that eosinophil degranulation contributes to myocardial damage, and the introduction (p. 1) describes cardiac failure in eosinophilic heart disease. The paper does not establish fibrosis as a subsequent consequence of the inflammation; Patient 1’s endocardium was reported as not fibrotic. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

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Cites

Flagged first, then by citations

Research works printed but not linked: 28

  1. [1]1. Löffler W. Endocarditis parietalis fibroplastica mit Bluteosinophilie: ein eigenartiges Krankheitsbild. Schweiz Med Wochenschr 1936; 17:817-20.
  2. [3]3. Davies J, Spry CJF, Sapsford R, et al. Cardiovascular features of 11 patients of eosinophilic endomyocardial disease. Q J Med 1983; 52:23-39.
  3. [2]2. Spry CJF, Davies J, Tai PC, Olsen EGJ, Oakley CM, Goodwin JF. Clinical features of fifteen patients with the hypereosinophilic syndrome. Q J Med 1983; 52:1-22.
  4. [5]5. Brockington IF, Olsen EGJ. Löffler's endocarditis and Davies' endomyocardial fibrosis. Am Heart J 1973; 85:308-22.
  5. [6]6. Goodwin JF, Oakley CM. The cardiomyopathies. In: Jones AM, ed. Modern trends in cardiology. Vol. 2. London: Butterworth, 1969:280-4.
  6. [8]8. Fenoglio JJ Jr, McAllister HA Jr, Mullick FG. Drug related myocarditis. I. Hypersensitivity myocarditis. Hum Pathol 1981; 12:900-7.
  7. [7]7. Smith JF. Disseminated focal necrosis with eosinophilia and arteritis in a case of asthma (? Loeffler's syndrome). J Pathol Bacteriol 1948; 60:48994.
  8. [9]9. Lennox B. Acute parietal endocarditis in a case of status asthmaticus: a possible early stage of Löffler's endocarditis parietalis fibroplastica with eosinophilia. J Pathol Bacteriol 1948; 60:621-8.
  9. [10]10. Baandrup U. Loffler's endocarditis and endomyocardial fibrosis: a nosologic entity? Acta Pathol Microbiol Scand [A] 1977; 85:869-74.
  10. [11]11. Chafee FM, Ross JR, Gunn EM. Eosinophilia in fatal asthma: studies of the bone marrow and myocardium. Ann Intern Med 1942; 17:45-59.
  11. [12]12. Brink AJ, Weber HW. Fibroplastic parietal endocarditis with eosinophilia: Löffier's endocarditis. Am J Med 1963; 34:52-70.
  12. [14]14. Parrillo JE, Fauci AS, Wolff SM. Therapy of the hypereosinophilic syndrome. Ann Intern Med 1978; 89:167-72.
  13. [13]13. Johny KV, Ananthachari MD. Cardiovascular changes in tropical eosinophilia. Am Heart J 1965; 69:591-8.
  14. [15]15. Herzog CA, Snover DC, Staley NA. Acute necrotizing eosinophilic myocarditis. Br Heart J 1984; 52:343-8.
  15. [17]17. Sasano H, Virmani R, Patterson RH, Rabinowitz M, Guccion JG. Eosinophilic products lead to myocardial damage. Hum Pathol 1989; 20:850-7.
  16. [16]16. Peters MS, Schroeter AL, Kephart GM, Gleich GJ. Localization of eosinophil granule major basic protein in chronic urticaria. J Invest Dermatol 1983; 81:39-43.
  17. [18]18. Dvorak AM. Ultrastructural evidence for release of major basic proteincontaining crystalline cores of eosinophil granules in vivo: cytotoxic potential in Crohn's disease. J Immunol 1980; 125:460-2.
  18. [20]20. Lie JT, Hunt D. Eosinophilic endomyocarditis complicating acute myocardial infarction: involvement of the cardiac conduction system. Arch Intern Med 1974; 134:754-7.
  19. [19]19. Taliercio CP, Olney BA, Lie JT. Myocarditis related to drug hypersensitivity. Mayo Clin Proc 1985; 60:463-8.
  20. [21]21. Ackerman SJ, Kephart G, Francis H, Awadzi K, Gleich GJ, Ottesen EA. Eosinophil degranulation: an immunologic determinant in the pathogenesis of the Mazzotti reaction in human onchocerciasis. J Immunol 1990; 144:3961-9.
  21. [23]23. Spry CJF, Tai PC. Studies on blood eosinophils. II. Patients with Löffler's cardiomyopathy. Clin Exp Immunol 1976; 24:423-34.
  22. [22]22. Parrillo JE, Fauci AS. Human eosinophils: purification and cytotoxic capability of eosinophils from patients with the hypereosinophilic syndrome. Blood 1978; 51:457-73.
  23. [24]24. Gleich ĠJ, Adolphson CR. The eosinophilic leukocyte: structure and function. Adv Immunol 1986; 39:177-253.
  24. [26]26. Gleich GJ. Current understanding of eosinophil function. Hosp Pract 1988; 23(3):137-60.
  25. [25]25. Gleich GJ, Frigas E, Loegering DA, Wassom DL, Steinmuller D. Cytotoxic properties of the eosinophil major basic protein. J Immunol 1979; 123:29257.
  26. [27]27. Tai PC, Hayes DJ, Clark JB, Spry CJ. Toxic effects of human eosinophil secretion products on isolated rat heart cells in vitro. Biochem J 1982; 204:75-80.
  27. [29]29. Tai P-C, Ackerman SJ, Spry CJF, Dunnette S, Olsen EGJ, Gleich GJ. Deposits of eosinophil granule proteins in cardiac tissues of patients with eosinophilic endomyocardial disease. Lancet 1987; 1:643-7.
  28. [28]28. Olsen EGJ, Spry CJF. The pathogenesis of Löffler's endomyocardial disease and its relationship to endomyocardial fibrosis. In: Yu PN, Goodwin JD, eds. Progress in cardiology. Vol. 8. Philadelphia: Lea & Febiger, 1979:290.

Cited by

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Authors
deMello, D. E., Liapis, H., Jureidini, S., Nouri, S., Kephart, G. M., & Gleich, G. J.
Affiliations
  • Saint Louis University (US)
  • Cardinal Glennon Children’s Medical Center (US)
  • Mayo Clinic (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1990-11-29
Volume
323
Issue
22
Pages
1542-1545
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm199011293232207
OpenAlex
W2338137185
Cited by
122
References
1
Citations by year
2026: 2 · 2025: 6 · 2024: 6 · 2023: 4 · 2021: 3 · 2020: 4 · 2019: 4 · 2018: 2 · 2017: 4 · 2016: 2 · 2015: 3 · 2013: 7 · 2012: 3
FWCI
6.00
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Allergy and Infectious Diseases (AI15231)
Topics
  • Health Sciences › Medicine › Rheumatology › Eosinophilic Disorders and Syndromes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Takotsubo Cardiomyopathy and Associated Phenomena
Keywords
eosinophilic myocarditis, major basic protein, eosinophil granules, eosinophilia, Löffler's endocarditis, endomyocarditis
MeSH terms
Acute Disease, Adolescent, Blood Proteins, Eosinophils, Female, Humans, Immunohistochemistry, Infant, Male, Myocarditis, Myocardium, Necrosis, Ribonucleases, Eosinophil Granule Proteins

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